We're all ears: Learning about earaches and infections

Staff Writer
Columbus Parent

As most parents have experienced, earaches and infections can be one of the most common ailments for newborns and toddlers.

Especially frustrating is that young ones cannot exactly describe the source of the pain to their parents, so we must become detectives to help relieve their suffering.

The pain in your child's ear can come from several sources. The most common causes of ear pain include:

  • Acute Otitis Media-an infection in the middle ear.
  • Otitis Externa-an infection of the outer ear canal, sometimes called swimmer's ear.
  • Blocked or plugged Eustachian tubes from colds or allergies.
  • A sore throat.
  • Toothache or sore gums.

"It is difficult to distinguish an ear ache from an ear infection,"said Dr. Dhanu Sant, a pediatrician with WholeKids Pediatrics in Columbus. "An ear infection can only be diagnosed by visualizing the ear drum with an instrument called an otoscope. An ear infection will be accompanied by fluid behind the ear drum that looks infected, usually thick and yellow, and the eardrum is often red and bulging."

Middle ear infections

The middle ear is located just inside the eardrum where there is a small tube connecting the ear to the throat. Infections can occur when germs from the nose and throat, usually associated with a cold, get trapped. This causes the tube to swell and become blocked, trapping fluid inside the ear. "The highest incidences occur starting at age 6 months up to 3 years because their tubes are anatomically smaller and get blocked more easily," said Dr. Richard Kang, chief of otolaryngology at Nationwide Children's Hospital and director of pediatric otolaryngology at The Ohio State University College of Medicine.

"Generally, we see a fever, a child pulling at the ear, general discomfort and not sleeping well. Some kids may have a very bad infection and they don't even have any symptoms. They might have a little fever, but they come in and their ears are very infected. You can't always rely on those symptoms, but certainly in most cases you would expect some signs to occur," Dr. Kang said. Most kids outgrow the problem about age 7, he added.

Outer ear infections

An outer ear infection occurs, according to Dr. Kang, when the lipid layer, which is a protective film that coats the outer ear canal, is removed (which sometimes happens during swimming) and becomes swollen shut.

Because it often occurs when excess water, sand and dirt enter the ear canal, it is called swimmer's ear. Unfor-tunately, once a child has swimmer's ear, he or she is at a greater risk for future infection. "The swimmer's ear can occur anytime, but it mostly occurs in older kids because they go swimming more often. Those pains are much worse than the otitis media, which sometimes surprises people," said Dr. Kang.


Ear infections often resolve on their own without any medication. Dr. Sant said various studies indicate a range of 30-75 percent of ear infections that resolve spontaneously. "Work closely with your physician to determine the best course of treatment for your child. Treatment options are watchful waiting to see if the infection resolves, pain management along with watchful waiting or antibiotics," said Dr. Sant.

Dr. Sant recommends using a warm compress against the ear. "A few drops of oil with garlic or mullein that are warmed slightly can alleviate the pain for many patients because they are anti-inflammatory agents. Prescription anesthetic ear drops are also available. Finally, pain relievers taken orally, such as acetaminophen or ibuprofen, can be used as well. Ear drops for pain should not be used if the ear drum is ruptured."

If a child is continually plagued with middle ear infections, the doctor may recommend that tubes be inserted in his or her ear. "We do have a guideline on when we recommend tubes," Dr. Kang said. "Generally it is when a child has more than six middle ear infections within a year. The other indication is when there is a persistent fluid that doesn't clear after the infection, which can lead to possible hearing loss."

Parents also should know that if they do not address their child's ear infection it could lead to serious health complications. Dr. Kang said that an untreated infection could spread to the brain and cause meningitis, along with the threat of possible hearing loss and facial palsy.


According to the American Academy of Pediatrics, children will exhibit many of the following symptoms if they have developed an infection. Consult your child's pediatrician for the best treatment for your child.

  • Pain: May seem irritable and cry, especially when feeding, because sucking and swallowing may cause painful pressure changes in the middle ear.
  • Loss of appetite: May eat less because of above-mentioned pain.
  • Trouble sleeping: Not sleeping well or waking often because of pain.
  • Fever: May range from 100F (normal) to 104F.
  • Ear drainage: Possible yellow or white fluid, may be blood-tinged.
  • Trouble hearing: Fluid behind the eardrum causes temporary hearing loss because it interrupts sound transmission.


  • Reduce exposure to viral illnesses, such as the common cold.
  • Wash hands often.
  • Eliminate smoke exposure.
  • Separate a sick child from other children, especially in daycare-type environments.
  • Eat a healthy diet.
  • Wean a baby from the pacifier after 12 months.
  • Avoid giving an infant a bottle at bedtime.

Pattie Stechschulte is a freelance magazine writer who lives in Westerville with her husband Steve and two sons, Will and Jack.